Top 10 Urodynamics Mistakes

BHN performs thousands of urodynamics procedures every year, and in performing these tests we have encountered many different types of mistakes. The list below highlights some of the mistakes seen most often. Our experience level helps us avoid these mistakes, but we thought others might benefit from this list.

Top 10 Urodynamics Mistakes

1. Timing of Measurements - Obtaining measurements for stress incontinence during a detrusor contraction. This can create erroneous data, false pressure recordings, and potentially invalidate the test.
2. Sensitive Bladder Screening - Not screening for the “sensitive bladder” (i.e. interstitial cystitis) and making protocol adjustments as needed during the urodynamic study.
3. Addressing Questions - Not allowing sufficient time prior to and after testing for questions. Ample time should be granted to address patient’s questions and concerns.
4. Patient Screening - Not appropriately screening for patients who may benefit from urodynamics (and Anorectal Manometry). This can be resolved by using a good patient questionnaire that BHN can provide.
5. Initiating Restart - Nurse fails to recognize when a urodynamic flow study may need to be repeated (e.g. catheter falls out during voiding or needs to be readjusted) or data artifacts are too great due to patient’s placement leaving the flow study unusable. When an event like this occurs the urodynamics nurse must recognize it and be prepared to restart the procedure in order to ensure quality data.
6. Patient Voiding and Preparation - Allowing patient to void prior to urodynamic study therefore missing the Uroflow (which is the first part of the test and is the purest part of the study as it is un-instrumented). This can be resolved by properly communicating with the patient prior to the test.
7. Proper Training - Allowing an inadequately trained/inexperienced nurse to perform the study without supervision. This is always problematic for urodynamics testing. Urodynamics is a very complicated procedure that requires ample training and dozens, if not hundreds of hours, of hands-on clinical work in order to master.
8. Patient Education - Not appropriately preparing the patient about the study, leading to fears and subsequent cancelation of appointments. If the patient is not properly educated then fear can arise and for certain patients the fear can prevent the test from being completed.
9. Patient Positioning – Improperly positioning the patient during the Uroflow and Cystometry test. It is common for a nurse with limited urodynamics testing experience to place the patient in a manner that causes the funnel to come in contact with the urine collection beaker. This can cause major data anomalies and corrupt the Uroflow and Voiding Cystometry test results. This can be avoided by positioning the patient where the funnel does not contact the beaker.
10. Incorrect billing/coding – Incorrect billing/coding is a problem in many medical practices. For urodynamics, this manifests itself in two primary ways. First, the wrong CPT codes are used. The CPT codes typically used for a complete urodynamics test are:
    • 51729 (Complex Cystometrogram),
    • 51784 (Electromyography),
    • 51797 (Voiding pressure studies), and
    • 51741 (Complex uroflowmetry).
    Second, the other billing issue often encountered occurs when urodynamics testing is performed immediately before or after another procedure such as a cystoscopy or an Interstim trial assessment. Performing urodynamics with other procedures can cause adjustments to certain reimbursement rates that should be researched thoroughly by each clinic.

We hope this short list will help your urodynamics practice. Please contact us if you have any questions about this list. You can email us at info@BHNCo.com.

Use this approach to avoid all mistakes!